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Action Against Hunger has developed its water and sanitation expertise over nearly three decades of field work, advancing a number of solutions for populations at risk from water insecurity.
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Action Against Hunger has developed its water and sanitation expertise over nearly three decades of field work, advancing a number of solutions for populations at risk from water insecurity.
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Central to the targeting of malnutrition, Action Against Hunger extends water and sanitation improvements to communities with little or no access to proper sources.
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Action Against Hunger's programs are sustainable because of our commitment to community participation—to build local capacity and harnesses a population's energy and resources.
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Though strategies may vary, our food security interventions all share a common goal: to fight hunger by preserving and strengthening livelihoods in a sustainable and contextual manner.
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Action Against Hunger’s innovative food security programs offer a broad range of solutions for generating income, boosting food production, and strengthening livelihoods.
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Our comprehensive approach to hunger involves extending water and sanitation services to communities faced with water scarcity, unsafe drinking water, and inadequate sanitation.
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Action Against Hunger occupies a unique place among international organizations: our expertise encompasses emergency relief, longer-term development, and the terrain in between.
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We have developed an effective method to treat acute malnutrition that includes field-tested protocols and nutritional products backed by an international scientific advisory committee.
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Action Against Hunger helps rehabilitate and restock public health infrastructure, fields mobile health clinics, and trains local medical personnel on preventative and diagnostic care.
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Our comprehensive programs address the linkages between disease and malnutrition by coordinating with local expertise and strengthening existing public health systems.
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Where We Work

Hunger Strategies

Curing Severel Malnutrition: Therapeutic Feeding

During food crises with large numbers of severely malnourished people, a specialized nutrition rehabilitation unit, or Therapeutic Feeding Center (TFC), has proved to be the most effective means of curing severe malnutrition. Therapeutic feeding provides a carefully balanced dietary regimen with intensive medical attention to rehabilitate severely malnourished patients and reduce mortality.


These are photos of a young girl named Afra in southern Sudan. The first photo was taken at the start of her intensive care (Phase I), and the second was taken at the end of Phase III (preparation for the return home), a time difference of just 30 days.

The TFC is at the heart of Action Against Hunger's emergency programs. In dozens of countries, Action Against Hunger has set up TFCs to treat the most vulnerable groups at the greatest risk of dying from malnutrition, usually children younger than five years old. As soon as malnourished patients arrive at a TFC, they are weighed and measured by nurses to verify their nutritional state and general health. The medical team identifies the severely malnourished, who must be admitted immediately to the TFC. After 30 days of nutritional and medical care, nearly all patients can be restored to health.

Criteria for Admission into a TFC:

  • Patients weigh 30% less than the standard weight for their height
  • Patients have a middle upper arm circumference (also called a MUAC) smaller than the norm (e.g. less than 11 centimeters for a four-year-old child)
  • And/or patients have edemas (pockets of water under the skin).

The treatment of severely malnourished patients is divided into different phases, which correspond to physiological changes during nutritional rehabilitation.

Phase I: Intensive Care (7 days)

Phase I aims to stabilize the patient's metabolism and treat associated infections. Patients admitted to Phase I are on the verge of death. They are so weak that they can no longer eat solid food. During this period, patients are given 8 to 12 meals a day, around the clock. They are fed small, regular amounts of specialized therapeutic milk known as F-75. Food intake is limited to small amounts. Psychological stimulation of children by their mothers and by personnel is crucial in getting the child to eat again. The objective is to restore metabolic functioning and to control infections.

The medical and nutritional condition of patients is monitored by nurses several times a day. Action Against Hunger's nurses also treat medical problems linked to malnutrition, such as anemia, dehydration (loss of body liquids), diarrhea, hypoglycemia (low sugar in the blood), hypothermia (low body temperature), and infections. Children are also vaccinated and receive vitamins.

Phase II: Recuperation & Weight Gain (15 - 20 days)

Phase II is designed to produce the optimal increase in a patient's weight. Consequently, the patient's diet changes: Patients drink a richer therapeutic milk, F100, and the number of milk meals is reduced to six. An enriched porridge meal is introduced for patients older than one year. Throughout this phase, the medical team monitors closely to ensure that patients gain weight regularly. Malnourished adults need to consume large quantities of F100 to meet their prescribed energy requirements.

Phase III: Preparation for the Return Home (7 days)

In the final stage of treatment, the medical team must prepare for a patient's return home. A family plate that contains the kind of food eaten at home is introduced, in addition to the therapeutic milk and porridge.

Patients are cured when they recover 85% of the standard weight for their size. They can then return home. However, Action Against Hunger's teams will remain in contact and prevent a relapse by checking their nutritional status and giving them food rations to supplement their normal diet. If needed, patients will be referred to a Supplementary Feeding Center (SFC), which treats moderate malnutrition.

Nutritional Products for the Treatment of Severe Malnutrition

Nutritional products recommended for the treatment of severe malnutrition are a mix of milk powder, lipids, and carbohydrates, supplemented with vitamins and minerals. Action Against Hunger's Scientific Committee helped pioneer the F100 therapeutic milk formula, which is used by all relief organizations to treat severe malnutrition and is incorporated in the World Health Organization handbook. A solid food product with the same composition as F100 is available. It is called Plumpy'nut and can be used at TFCs in place of F100 milk during Phase II.

Preventing Malnutrition: Targeted Supplementary Feeding

Supplementary Feeding Centers (SFCs) can take two forms. Some distribute cooked ("wet") rations and are set up similarly to TFCs, except that treatment is not organized into phases. Wet rations are prepared once or twice daily and consumed on-site. Mothers or other caretakers must bring children to the feeding center every day. Other SFCs distribute dry rations, usually weekly, for "take-home" preparation and consumption. In terms of effectiveness, the level of weight gain is the same whether dry rations or wet rations are used. The choice of which type of SFC to set up depends on: the number of patients anticipated, the area the center needs to service, cooking facilities available to families, and security conditions.

Patients also receive booster doses of vitamin A and regular doses of iron supplements to compensate for deficiencies. Most patients are treated for intestinal parasites, and children are vaccinated against measles.

Detecting Malnutrition: Nutritional Surveillance

When dealing with populations in emergency situations, the population's nutrition must be assessed quickly and precisely. This evaluation is based on surveillance data, demographic indicators, direct observation, advice from experts, and rapid anthropometric surveys that measure the prevalence of malnutrition. The objectives of these surveys include: quantifying the presence of malnutrition in a specified population; identifying higher risk groups; estimating the number of children who may benefit from a nutrition program; assessing trends in nutrition status; evaluating and adjusting established programs; and comparing the nutrition status of refugees with that of the local population.

In TFCs and SFCs, patients' nutritional status must be checked regularly. If they have failed to gain weight, causes must be investigated. Each patient must be monitored for daily weight measurement, growth curve, edema assessment, clinical examination, temperature, and medical/nutritional treatment plan. Food needs and meal frequency then must be calculated individually and marked on patients' charts. Nurses must discuss patients' health and weight gain with them.

Action Against Hunger sets up sentinel sites to monitor malnutrition among populations, such as in Lubumbashi, Western Congo. Health workers also make home visits in communities to identify women and children who require therapeutic or supplementary feeding and to ensure that they are enrolled in the program.

Improving Food Security: Long-term Plan

In emergencies, populations turn to coping mechanisms to deal with reduced access to food. Action Against Hunger reinforces coping mechanisms through its programs designed to improve food security, i.e. to increase the constant availability of food, with the objective of helping vulnerable populations regain self-sufficiency.

We distribute seeds and tools, and we conduct training programs in income-generating activities such as animal breeding, farming, fishing, food conservation, and gardening. These programs are aimed at attacking the underlying causes of hunger by building local agriculture, capacities, and market systems.

General Food Distribution: a Short-Term Food Security Measure

In certain emergency situations, the self-reliance of the population is reduced to such an extent that victims become totally dependent on humanitarian aid. The classic intervention to meet basic food needs of refugees and internally displaced people is a General Food Distribution (GFD). Although GFDs provide food immediately to everyone in a victimized population, humanitarian distributions have several important disadvantages that usually outweigh the advantages. First, the neediest people are not specifically targeted. Second, the amount of food and transportation required makes such programs very expensive. But the biggest disadvantage is that introducing surplus food into a community can slow agricultural recovery, harm farmers and small merchants, and create dependency. Phasing out such a program may also be difficult and disruptive.

Fighting at all levels: Advocacy for Hunger

Action Against Hunger firmly believes that, in addition to saving lives in the field, it is also necessary to take action on home fronts by advocating on issues that will create progress in the fight against hunger. It is part of our mandate to speak out for victims and testify about unacceptable situations that we see in the field, both to decision-makers and to the general public.

Action Against Hunger advocates for:
  • Increased development assistance from industrialized countries
  • Debt relief for the world's poorest nations
  • Fair trade: opening international markets to developing countries
  • International recognition of a universal right to food
  • Warring factions to respect civilian populations and the humanitarian organizations assisting them

Hunger cannot be ended without public education and awareness that increases political will. Action Against Hunger carried out a project entitled, "World Hunger and Sustainable Development: Why Should Americans Care?" The program reaches 20 million Americans, including high school teachers and students, with the compelling message that the issues of hunger and international development are relevant to the lives of U.S. citizens. It teaches about local-global interdependence, food security issues, and relief and international development by way of audio CDs, the Internet, and radio.

At regional and national levels of the countries where we work, Action Against Hunger strives to integrate its proven nutritional protocol into the government's health plan. This formal acknowledgement of a malnutrition problem is a key step in providing the means and the will to tackle the problem, and it's essential in developing a methodology to achieve acceptable nutritional standards.

At the family and community level, Action Against Hunger educates beneficiaries about proper nutrition, hygiene, and health care, especially targeting mothers. Local staff and beneficiaries are trained in recognizing, treating, and preventing malnutrition.

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